TPA readiness without premature authority.
Theo's current focus is expert coordination, consulting, field assessment support, and technical documentation. Claim administration services require appropriate contracts, authority, licensing, insurance, staffing, and carrier requirements.
The readiness work is designed to build disciplined workflows now so future programs can be supported with structure, quality control, and clear boundaries.
This page describes operational readiness and infrastructure planning. Theo will not market or perform claim administration, payment authority, policy interpretation, claim decision authority, or TPA services unless the required authority, contracts, licensing, insurance, and staffing are in place.
Readiness Domains
| Domain | Buildout Focus |
|---|---|
| Intake and assignment | Standardized claim setup, assignment type coding, document receipt, due dates, and carrier instructions. |
| Diary and status control | Follow-up cadence, escalation triggers, pending item logs, report due dates, and file status reporting. |
| Quality assurance | Report review standards, attachment checks, authority boundaries, estimate support, and file closure controls. |
| Compliance and security | Licensing roadmap, data retention, confidentiality, cybersecurity, complaint handling, and conflict controls. |
Readiness Areas
- Claim intake and assignment workflow design
- Diary management and status reporting procedures
- Vendor management and performance tracking
- Quality assurance and report review standards
- Carrier instruction and escalation procedures
- Data retention, confidentiality, and cybersecurity standards
SOP Library to Build Toward
- Claim intake and document receipt procedure
- Assignment and vendor management procedure
- Diary, pending item, and escalation procedure
- Report review and QA procedure
- Carrier instruction and authority control procedure
- Litigation hold and sensitive file handling procedure
- Data retention and cybersecurity procedure
- File closure and final reporting procedure
Program Support
Workflow Documentation
Standard operating procedures for intake, assignment, report review, file status, and closure support.
Carrier Reporting
Structured reporting templates for status, open issues, vendor performance, and claim file metrics.
QA Framework
Review standards designed to support consistency, documentation quality, and authority controls.